Risk Factors of Sudden Cardiac Death in the Young: Multiple-Year Community-Wide Assessment

Reshmy Jayaraman, Kyndaron Reinier, Sandeep Nair, Aapo L. Aro, Audrey Uy-Evanado, Carmen Rusinaru, Eric Stecker, Karen Gunson, Jonathan Jui, Sumeet S. Chugh

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Prevention of sudden cardiac arrest (SCA) in the young remains a largely unsolved public health problem, and sports activity is an established trigger. Although the presence of standard cardiovascular risk factors in the young can link to future morbidity and mortality in adulthood, the potential contribution of these risk factors to SCA in the young has not been evaluated. Methods: We prospectively ascertained subjects who experienced SCA between the ages of 5 and 34 years in the Portland, Oregon, metropolitan area (2002-2015, catchment population ≈1 million). We assessed the circumstances, resuscitation outcomes, and clinical profile of subjects who had SCA by a detailed evaluation of emergency response records, lifetime clinical records, and autopsy examinations. We specifically evaluated the association of standard cardiovascular risk factors and SCA, and sports as a trigger for SCA in the young. Results: Of 3775 SCAs in all age groups, 186 (5%) occurred in the young (mean age 25.9±6.8, 67% male). In SCA in the young, overall prevalence of warning signs before SCA was low (29%), and 26 (14%) were associated with sports as a trigger. The remainder (n=160) occurred in other settings categorized as nonsports. Sports-related SCAs accounted for 39% of SCAs in patients aged ≤18, 13% of SCAs in patients aged 19 to 25, and 7% of SCAs in patients aged 25 to 34. Sports-related SCA cases were more likely to present with shockable rhythms, and survival from cardiac arrest was 2.5-fold higher in sports-related versus nonsports SCA (28% versus 11%; P=0.05). Overall, the most common SCA-related conditions were sudden arrhythmic death syndrome (31%), coronary artery disease (22%), and hypertrophic cardiomyopathy (14%). There was an unexpectedly high overall prevalence of established cardiovascular risk factors (obesity, diabetes mellitus, hypertension, hyperlipidemia, smoking) with ≥1 risk factors in 58% of SCA cases. Conclusions: Sports was a trigger of SCA in a minority of cases, and, in most patients, SCA occurred without warning symptoms. Standard cardiovascular risk factors were found in over half of patients, suggesting the potential role of public health approaches that screen for cardiovascular risk factors at earlier ages.

Original languageEnglish (US)
Pages (from-to)1561-1570
Number of pages10
JournalCirculation
Volume137
Issue number15
DOIs
StatePublished - Apr 10 2018

Fingerprint

Sudden Cardiac Death
Sports
Public Health
Hypertrophic Cardiomyopathy
Sudden Death
Hyperlipidemias
Heart Arrest
Resuscitation
Coronary Artery Disease
Autopsy
Diabetes Mellitus
Emergencies

Keywords

  • death, sudden, cardiac
  • epidemiology
  • heart arrest
  • population
  • prevention & control
  • risk factors
  • sports

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Jayaraman, R., Reinier, K., Nair, S., Aro, A. L., Uy-Evanado, A., Rusinaru, C., ... Chugh, S. S. (2018). Risk Factors of Sudden Cardiac Death in the Young: Multiple-Year Community-Wide Assessment. Circulation, 137(15), 1561-1570. https://doi.org/10.1161/CIRCULATIONAHA.117.031262

Risk Factors of Sudden Cardiac Death in the Young : Multiple-Year Community-Wide Assessment. / Jayaraman, Reshmy; Reinier, Kyndaron; Nair, Sandeep; Aro, Aapo L.; Uy-Evanado, Audrey; Rusinaru, Carmen; Stecker, Eric; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S.

In: Circulation, Vol. 137, No. 15, 10.04.2018, p. 1561-1570.

Research output: Contribution to journalArticle

Jayaraman, R, Reinier, K, Nair, S, Aro, AL, Uy-Evanado, A, Rusinaru, C, Stecker, E, Gunson, K, Jui, J & Chugh, SS 2018, 'Risk Factors of Sudden Cardiac Death in the Young: Multiple-Year Community-Wide Assessment', Circulation, vol. 137, no. 15, pp. 1561-1570. https://doi.org/10.1161/CIRCULATIONAHA.117.031262
Jayaraman R, Reinier K, Nair S, Aro AL, Uy-Evanado A, Rusinaru C et al. Risk Factors of Sudden Cardiac Death in the Young: Multiple-Year Community-Wide Assessment. Circulation. 2018 Apr 10;137(15):1561-1570. https://doi.org/10.1161/CIRCULATIONAHA.117.031262
Jayaraman, Reshmy ; Reinier, Kyndaron ; Nair, Sandeep ; Aro, Aapo L. ; Uy-Evanado, Audrey ; Rusinaru, Carmen ; Stecker, Eric ; Gunson, Karen ; Jui, Jonathan ; Chugh, Sumeet S. / Risk Factors of Sudden Cardiac Death in the Young : Multiple-Year Community-Wide Assessment. In: Circulation. 2018 ; Vol. 137, No. 15. pp. 1561-1570.
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AU - Aro, Aapo L.

AU - Uy-Evanado, Audrey

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N2 - Background: Prevention of sudden cardiac arrest (SCA) in the young remains a largely unsolved public health problem, and sports activity is an established trigger. Although the presence of standard cardiovascular risk factors in the young can link to future morbidity and mortality in adulthood, the potential contribution of these risk factors to SCA in the young has not been evaluated. Methods: We prospectively ascertained subjects who experienced SCA between the ages of 5 and 34 years in the Portland, Oregon, metropolitan area (2002-2015, catchment population ≈1 million). We assessed the circumstances, resuscitation outcomes, and clinical profile of subjects who had SCA by a detailed evaluation of emergency response records, lifetime clinical records, and autopsy examinations. We specifically evaluated the association of standard cardiovascular risk factors and SCA, and sports as a trigger for SCA in the young. Results: Of 3775 SCAs in all age groups, 186 (5%) occurred in the young (mean age 25.9±6.8, 67% male). In SCA in the young, overall prevalence of warning signs before SCA was low (29%), and 26 (14%) were associated with sports as a trigger. The remainder (n=160) occurred in other settings categorized as nonsports. Sports-related SCAs accounted for 39% of SCAs in patients aged ≤18, 13% of SCAs in patients aged 19 to 25, and 7% of SCAs in patients aged 25 to 34. Sports-related SCA cases were more likely to present with shockable rhythms, and survival from cardiac arrest was 2.5-fold higher in sports-related versus nonsports SCA (28% versus 11%; P=0.05). Overall, the most common SCA-related conditions were sudden arrhythmic death syndrome (31%), coronary artery disease (22%), and hypertrophic cardiomyopathy (14%). There was an unexpectedly high overall prevalence of established cardiovascular risk factors (obesity, diabetes mellitus, hypertension, hyperlipidemia, smoking) with ≥1 risk factors in 58% of SCA cases. Conclusions: Sports was a trigger of SCA in a minority of cases, and, in most patients, SCA occurred without warning symptoms. Standard cardiovascular risk factors were found in over half of patients, suggesting the potential role of public health approaches that screen for cardiovascular risk factors at earlier ages.

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